Kindly take the time to READ and COMPLETE this employment
application in its entirety.
Legible copies (front and back) of your certifications and driver's license need to be submitted at the time of
your interview.

Motor vehicle driving record will be obtained for review during applicant processing.
Additionally, any offer of employment with Old Bridge Township EMS will be
contingent upon successful drug testing, skills and lift testing and an acceptable motor vehicle record.

Should you have any questions pertaining to the application process,
please submit a General Purpose Contact Request Form that can be found on our home page.

Some positions might require working
overtime, weekends, evenings, and holidays.Is this acceptable? YES
NO

Are you employed now?
YES
NO

If so may we inquire of your present employer?
YES
NO

Have you ever applied for OBTEMS before?
YES
NO

If so, when?

Have you ever worked for OBTEMS before?
YES
NO

If so, when?

Reason for Leaving

Name of last supervisor at OBTEMS

Who referred you to OBTEMS?
Employment Agency
Newspaper Advertising
Friend
State Employment Office
College Placement Service
Walk In
Other

Do you have any relatives employed by OBTEMS?
YES
NO

If so what is their relationship to you?

Education - Must be 18 years old and have a high school diploma or GED

Name and Location of School

Years Attended

Date Graduated

Fields of Study

Grammar School

High School

College

Trade, Business, or Correspondence School

Qualifications

EMT Certification

Certification No.

Expiration

CPR Certification

Certification No.

Expiration

DL Number

License No.

Expiration

Other Certification #1 (List if applicable)

Other Certification #2 (List if applicable)

Where did you take your EMT Class?

Instructor's Name

Former Employers (List below: last three employers, starting with the most recent)

Name of present or most recent employer

Address

City

State

Zip

Start Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May we contact your supervisor?
YES
NO

Name of Supervisor

Title

Phone

Description of work

Reason for Leaving

Name of previous employer

Address

City

State

Zip

Start Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May we contact your supervisor?
YES
NO

Name of Supervisor

Title

Phone

Description of work

Reason for Leaving

Name of other previous employer

Address

City

State

Zip

Start Date

Leaving Date

Job Title

Weekly Starting Salary

Weekly Final Salary

May we contact your supervisor?
YES
NO

Name of Supervisor

Title

Phone

Description of work

Reason for Leaving

References(Below, give the names of three persons you are not related to whom you have known for at least one year)

Name

Address

Phone

Years Acquainted

Military Service Record

Branch of Service

Discharge Date

Rank

EEO Data (voluntary)

To better evaluate the effects of our selection process and to enable us to meet government reporting requirements, applicants for positions at Old Bridge Township EMS are asked to complete this information. Your cooperation is voluntary and will be appriciated. Refusal to provide this data will not subject you to any adverse treatment. Any Information you provide will be treated as confidential and will only be used in accordance with applicable federal laws and regulations.

Race Ethnic (choose only one)

White

Not of Hispanic origin. Person having origins in Europe, North Africa, or the Middle East.

Black

Persons having origins in the black racial groups of Africa as well as Jamaica, Trinidad, or the West Indies.

Asian/Pacific Islander

Persons having origins in the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, and Samoa.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this applications shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any
authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing or signed by an authorized company representative.

By clicking Submit, I agree to the preceding statement.
I am clicking the Submit button in lieu of placing my written signature on this application for the purpose of online submittal, and
understand
that I will be required to physically sign a hard-copy at the time of my interview.

In an effort to curb spam and be sure you are a live person submitting this form:You MUST first enter the LAST 4 DIGITS of this application's Serial No. IN REVERSE, in the box below! Example: If your application Serial No. was 2399195271 then you would enter 1725 ~ Simple but necessary ~

Be sure you entered the digits in the box above! Failing to do so could make you start over again.

!! PLEASE PRINT yourself a copy of this completed application BEFORE submitting in case you don't receive an emailed applicant copy.
It is always best to be prepared for the unknown in our line of work !!